Calculatn of Fluid Requirmt

CALCULATION OF FLUID
REQUIREMENT
OBJECTIVES
• fluid requirement
• Signs that a child requires more
fluid
• Good sources of Fluid
• Calculation of fluid requirement
• Calculation if IV flow rate
• Neonatal fluid requirement
• Fluid requirement of low birth
weight babies
Introduction
Children’s fluid needs are proportionally
greater than those of adults, so children
are more vulnerable to changes in fluid
and electrolyte balance.
Extracellular fluid has a higher

percentage of water, children’s fluid
exchange rates are two or three times
greater than those of adults.
The fluid requirement of children is

fluid requirement
0-12 months: 150ml/kg/day (for
example, a child weighing 7kg
should have approximately
1050ml/day)
1-3 years : 120ml/kg/day (for

example, a child weighing 10kg
should have approximately
1200ml/day)
Over 3 years: 1000-1500ml

SIGNS THAT A CHILD REQUIRES MORE FLUID
 Strong smelling nappies

 Yellow urine
 Less wet nappies than normal
 Constipation
 Headaches, tiredness
 Dry lips and skin
 More thirsty than usual
 Dark circles around eyes
 Weight loss
CALCULATION OF FLUIDS REQUIREMENT:
Formula method
4/2/1 method
Formula method
Three ways to calculate the number of mili

liters of fluid a child needs based on:
 Weight in kilograms.
 Metabolism (calories required).
 BSA in square meters.

Weight in kilograms:
 Childs weight less than 10kg requires 100ml of fluid
per kg body weight.
(Fluid needs in ml/day =Weight in kg x 100ml/kg/day)
 Child weight 10-20kg requires 1000ml of fluid per day

for first 10kg plus 50ml for every kilogram over 10
kg.
1000ml/day + additional fluid need= fluid needs in
ml/day
 Child weight more than 20kg require 1500ml of fluids

for the first 20kg plus 20ml for each additional kg.
15000ml/day +additional fluid need= fluid need in
ml/day
Scale: Daily maintenance fluid
needs
Weight Fluid needs per
24 hours
Newborn (0–72 hours) 60–100 ml/kg
0–10 kg (0–22 lb) 100ml/kg
11-20kg (24-44lb) 1000ml plus 50ml/kg>10kg
1500ml plus 20ml/kg>20kg

>20kg(>44lb)
Fluid need based on calories:
 Find the child’s calorie requirement. This
information can be taken from a table of
recommended dietary allowances for children.
 Divide the calorie requirements by 100 kcal.
 Multiply the results by 120ml, the amount of

fluid required for every 100kcal.
Fluid requirements in ml/day = calorie
requirement x 120ml
100kcal
Fluid need based on BSA(body
surface area):
 Fluid maintenance needs in ml/ day =
BSA in m2 x 1500ml/day/m2
FLUID REQUIREMENTS BASED ON
HOLLIDAY-SEGAR METHOD:
Calculate the hourly maintenance
fluid rate for a child who weighs
25kg
(100mL x 10kg) + (50mL x 10kg)

+ (20mL x 5kg) / 24hrs
(1000mL) + (500mL) + (100mL) =

1600mL / 24hrs = 66.7ml/hr
Using this formula the hourly fluid

maintenance for this child is
67mL/hr
4/2/1 METHOD:
 (4ml/kgfor the first 10kg) + (2ml/kg

for kg 11-20) + (1ml/kg for every kg
above 20) = hourly rate
4 ml/kg/hr for the first 10 kg,

Adding 2 ml/kg/ hr for the second
10 kg
1 ml/kg/hr for each kg over 20 kg.
Example:
Calculate the hourly maintenance

fluid rate for a child who weighs
25kg…..
(4ml x 10kg) + (2ml x 10kg) + (1ml x

5kg) = hourly rate
40ml + 20ml + 5ml = 65ml/hr
Using the 4/2/1 method, this child's

hourly maintenance fluid rate is
65mL/hr
CALCULATION OF IV FLOW RATE (DROPS
PER MINUTE) :
 Common drop factors are:

10 drops/ml (blood set), 15 drops / ml
(regular set), and 60 drops / ml (micro
drop).
 To measure the rate we must know,

(a) the number of drops
(b) time in minutes.
CALCULATION OF IV FLOW RATE (DROPS
PER MINUTE) :
The formula for working out flow rates is:
volume (ml) X drop

= gtts / min
factor (gtts / ml)
(flow rate) Where
--------------------------- gtts=drops
------------------
time (min)
CALCULATION OF IV FLOW RATE
(DROPS PER MINUTE) :
Example: 1500 ml IV Saline is ordered

over 12 hours. Using a drop factor of 15
drops / ml, how many drops per minute
need to be delivered?
1500 (ml) X
15 (gttss / ml)
------------------- = 31 gtts /
-------------12 x minute
60 (gives us
NEONATAL FLUID REQUIREMENTS:
The daily fluid requirement of the infant

depends on:
 The BODY WEIGHT: Fluid requirements

are expressed in ml per kg of body
weight.
 The AGE AFTER DELIVERY : Fluid

requirements increase gradually from
birth to day 5 and then remain stable.
Fluid requirements of low birth
weight babies: (ml/kg/day)
Day <1000g 1000- >1500g

1500g
1st& 2nd 100- 80-100 60-80
120
3rd&4th 130- 100- 90-100
140 120
5th & 6th 150- 130- 110-
160 140 120
th th
Fluid Requirements term babies (weight
over 2500 grams)
Day of life Ml/kg/day

1 65-80
2 80
3 100
4 120
5 135-150
NORMAL IV FLUID USED
Electrolyte Requirements
Sodium: 2-3 mEq/kg/day
(starting on day 2). Usually
administer 1/4 NS
Potassium: 2-3 meq/kg/day
(starting on day 2)
Calcium: 30-45 mg/kg/day.
TYPES OF INTRAVENOUS FLUID USED
Resuscitation fluid.
Maintenance fluid.
Replacement fluid.
Total parenteral nutrition.

Resuscitation fluid.
Indication: Hypoxia, septicemia or blood loss.
RESUSCITATION fluids are:
 Normal saline (0.9%)
 Blood.
 Stabilised human serum (SHS).
 Fresh frozen plasma.
 Plasmalyte B.
 Ringer's lactate.
 Haemaccel.
Resuscitation fluid is given 10-20 ml/kg over 10-
20 minutes until normal perfusion and blood
pressure are achieved. In severe shock it must
Maintenance fluid
 It is used to supply the daily requirements of
water and electrolytes.
 It is given to infants that cannot be fed by

mouth or naso gastric tube.
 It will provide the infant with the correct

amount of electrolytes if the correct volume per
kg is given a day.
 Breast milk provides the term infant with 1

mmol sodium/kg/day. Some preterm infants
Replacement fluid
It is used to correct the fluid and electrolyte balance after
excess fluid and electrolyte has been lost in the stool,
urine, sweat or by vomiting. Therefore, replacement fluid
is used to correct dehydration.
Replacement fluids are:
• Half-strength Darrow's.
• Half-normal saline.
 Replacement fluids contain 3 times more sodium than
maintenance fluids. In addition, half strength Darrow's
contains a lot of potassium and is, therefore, used to
replace fluid losses in gastroenteritis.
 Half-normal saline does not contain potassium and is,

therefore, used to replace fluid lost by vomiting and
excessive sweating where sodium and water but not
potassium are lost.
Total parenteral nutrition
 Total parenteral nutrition (or TPN) is
used to meet all the fluid, electrolyte
and nutritional requirements of an
infant who cannot be fed by mouth or
nasogastric tube for more than a few
days.
 Total parenteral nutrition is only used in

hospitals with special expertise in
parenteral feeding.
NURSING RESPONSIBILITY:
• Patients receiving IV therapy need to be monitored to

ensure that the IV solutions are providing the correct
amounts of fluids and minerals needed.
• Correct dose of fluids should be administered according

to written doctor’s order.
• Care should be taken to prevent hospital acquired

hyponetremia.
• Flow rate should be calculated accurately.
• Children with kidney and heart disease are at increased

risk for over-hydration, so they must be carefully
monitored when receiving IV therapy.
NURSING RESPONSIBILITY:
• Patients need to take fluids by mouth before
an IV solution is discontinued. After the IV
needle is removed, the site should be
inspected for any signs of bleeding or
infection.
• There is a small risk of infection at the
injection site that is usually treated topically. It

CONCLUSION:
Queries !!!
Lets summarize…
REFERENCE:
• Singh Meharban. Care of the Newborn. 6 th edition. Sagar publications: New
Delhi;2004
• Williams Lippincott, Wilkins. Dosage calculations.3 rd edition. Wolters Kluwer
Company: Philadelphia;2005
• Booker f. Maryliyn, D. Donna. Infusion therapy techniques and medications.
1st edition.W.B.Saunders Company: Philadelphia; 1996
NET REFERENCE
• Fluid requirements is retrieved from
www.gfmer.ch/PEP/pdf/UNIT-21-2005.pdf
• Fluid resuscitation retrieved from
www.impactednurse.com/?p=764
• Fluid requirements for children is retrieved from
www.articles.complexchild.com/00037.pdf
• Intravenous fluid requirements retrieved from
www.rch.org.au/clinicalguide/guideline_index/Intravenous_Fluids/
Intravenous Rehydration - Definition, Purpose, Description, Risks
Retrieved from http://www.healthofchildren.com/I-K/Intravenous-
Rehydration.html#ixzz28iyOskbq
Thank
you

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CALCULATION OF FLUID

• Signs that a child requires more

• Good sources of Fluid

• Calculation of fluid requirement

• Calculation if IV flow rate

• Neonatal fluid requirement

• Fluid requirement of low birth

Extracellular fluid has a higher

The fluid requirement of children is

1-3 years : 120ml/kg/day (for

Over 3 years: 1000-1500ml

 Strong smelling nappies

Three ways to calculate the number of mili

 Metabolism (calories required).

 BSA in square meters.

 Child weight 10-20kg requires 1000ml of fluid per day

 Child weight more than 20kg require 1500ml of fluids

11-20kg (24-44lb) 1000ml plus 50ml/kg>10kg

1500ml plus 20ml/kg>20kg

 Divide the calorie requirements by 100 kcal.

 Multiply the results by 120ml, the amount of

 Fluid maintenance needs in ml/ day =

(100mL x 10kg) + (50mL x 10kg)

(1000mL) + (500mL) + (100mL) =

Using this formula the hourly fluid

 (4ml/kgfor the first 10kg) + (2ml/kg

4 ml/kg/hr for the first 10 kg,

Calculate the hourly maintenance

(4ml x 10kg) + (2ml x 10kg) + (1ml x

Using the 4/2/1 method, this child's

 Common drop factors are:

 To measure the rate we must know,

volume (ml) X drop

Example: 1500 ml IV Saline is ordered

The daily fluid requirement of the infant

 The BODY WEIGHT: Fluid requirements

 The AGE AFTER DELIVERY : Fluid

Day <1000g 1000- >1500g

Day of life Ml/kg/day

Total parenteral nutrition.

 It is given to infants that cannot be fed by

 It will provide the infant with the correct

 Breast milk provides the term infant with 1

 Half-normal saline does not contain potassium and is,

 Total parenteral nutrition is only used in

• Patients receiving IV therapy need to be monitored to

• Correct dose of fluids should be administered according

• Care should be taken to prevent hospital acquired

• Flow rate should be calculated accurately.

• Children with kidney and heart disease are at increased

• Patients need to take fluids by mouth before

an IV solution is discontinued. After the IV

needle is removed, the site should be

inspected for any signs of bleeding or

• There is a small risk of infection at the

injection site that is usually treated topically. It

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